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Ergonomics: Health Implications for Dental Hygienists. Dr. John H. Park, DC, CSCS Progressive Spinal & Sports Rehab 10076 Darnestown Road Suite 200 Rockville, MD 20850. Overview: Ergonomics and Health Implications for Dental Hygienists. Increase awareness

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ergonomics health implications for dental hygienists

Ergonomics: Health Implications for Dental Hygienists

Dr. John H. Park, DC, CSCS

Progressive Spinal & Sports Rehab

10076 Darnestown Road

Suite 200

Rockville, MD 20850

overview ergonomics and health implications for dental hygienists
Overview: Ergonomics and Health Implications for Dental Hygienists
  • Increase awareness
  • Decrease work-related pain and injuries
  • Heighten productivity
  • Improve musculoskeletal health
  • Increase comfort
  • Improve quality of life
  • Extend careers
what is ergonomics
What is Ergonomics?
  • Ergonomics is the study of workers and their relationship with their occupational environment
  • How you position yourself, your patient, how equipment is utilized, how the workplace is designed and how it impacts your health
  • ERGONOMICS is a way to work smarter, more efficiently with less effort and discomfort to the human body
ergonomics in the dental health field
Studies show work-related pain in the dental field is not decreasing

Over half of all dental professionals continue to experience work-related pain

Why? The physically challenging nature of the work with numerous risk factors

Risk Factors

Prolonged Static Postures

Repetitive Movements

Working in a confined space

Challenges with positioning yourself or the patient

Limitations with the tools and equipment used

Ergonomics in the Dental Health Field
ergonomics the human factor
Ergonomics: The Human Factor
  • People Are Different

We come in different shapes and sizes yet the workplace is often set up for “one size fits all”

  • People Have Limitations

We have physical and mental limits for working

- The wrist cannot tolerate excessive extension

- The back cannot tolerate excessive bending or twisting

- The neck was not meant to be in constant flexion

- Muscles will fatigue if under constant tension

consequences of poor ergonomics
Consequences of Poor Ergonomics
  • Fatigue
  • Pain/Discomfort
  • Illness/Injury
  • Missed days at work
  • Errors
  • Lower productivity
  • Patient dissatisfaction
poor ergonomics signs and symptoms
Physical Signs

Decreased range of motion


Decreased grip strength

Loss of muscle function








Poor Ergonomics: Signs and Symptoms
poor ergonomics musculoskeletal disorders
Poor Ergonomics = Musculoskeletal Disorders

The World Health Organization definition:

Musculoskeletal Disorderis “a disorder of the muscles, tendons, peripheral nerves or vascular system not directly resulting from an acute trauma or instantaneous event”

Two Most Common Causes for Musculoskeletal

Disorders in the Dental Health Profession

Cumulative Traumas

Prolonged Static Postures

cumulative trauma
Cumulative Trauma
  • Repetitive Movements like Scaling and Polishing are Cumulative Traumas
  • Vibrations transmitted by dental handpieces or mechanical scalers are Cumulative Traumas
  • Cumulative Traumas add up

These microtraumas cause “wear and tear” on the muscles, tendons, and nerve tissue

prolonged static postures
Prolonged Static Postures
  • Human body was designed for movement
  • Dental hygiene procedures means practitioners must maintain static postures
  • Hygienists hold postures that require more than 50% of the body’s muscles to contract to resist gravity
  • Muscle overload leads to decreased blood flow and increased pressure on the muscles and joints
static postures leads to muscular imbalances
Static Postures leads to Muscular Imbalances
  • Muscles responsible for rotating the body to one side become tighter (shorter), while opposing muscles become weaker (longer)
  • Right handed hygienists repeatedly assume NECK ROTATION TO LEFT with SIDE-BENDING TO RIGHT to gain better visibility
static postures muscle ischemia
Static Postures=Muscle Ischemia
  • As postures deviate from neutral, muscles contract harder to maintain working postures
  • During static muscle contraction, the vascular supply to muscle and surrounding tissues is restricted
  • Results in depleted nutrient and oxygen supply (ischemia)
  • Lactic acid and other metabolites accumulates causing pain and tissue damage
cumulative traumas and prolonged static postures lead to musculoskeletal disorders
Trigger Points and Myofascial Pain Disorders of Neck

Degenerative Joint Disease (Arthritis)

Thoracic Outlet Syndrome


Carpal Tunnel


Trigger Finger

Nerve Entrapment Syndromes

Lower Back Pain


Cumulative TraumasandProlonged Static Postures Lead to Musculoskeletal Disorders
myofascial pain trigger points
Myofascial Pain: Trigger Points
  • Trigger Points: groups of muscle fibers that are in a constant state of contraction inside a tight band of muscle
  • Feels like a knot or a small pea in muscles, and when pressed on can refer pain to distant parts of the body
  • Ischemic areas are susceptible to the development of trigger points
static postures degenerative joint disease
Static Postures: Degenerative Joint Disease
  • Synovial fluid, which lubricates the joints, is produced each time a joint moves
  • Lack of movement and contracted muscles from static postures reduces the synovial fluid production, resulting in joint hypomobility
  • This loss of mobility leads to degenerative changes and more musculoskeletal disorders
static postures degenerative joint disease17
Static Postures: Degenerative Joint Disease


  • Intermittent/chronic pain and stiffness
  • “Creaking” or “cracking” of joints
  • Swelling in the joints
  • Loss of motion in the joints
  • Increased pain with activity or use
neck and shoulder disorders thoracic outlet syndrome
Neck and Shoulder DisordersThoracic Outlet Syndrome
  • Condition resulting from compression of the nerves, arteries, and veins as they pass through from the neck to the arm (thoracic outlet)
  • Possible causes: tight scalenes, cervical rib, tight pectoralis muscle, traumas
  • Often misdiagnosed
neck and shoulder disorders thoracic outlet syndrome19
Neck and Shoulder DisordersThoracic Outlet Syndrome


  • Pain in the neck, shoulder, arm or hand
  • Numbness and tingling of fingers
  • Muscle weakness/fatigue
  • Cold sensation in the arm, hand or fingers
cumulative trauma injury tendinitis
Cumulative Trauma Injury: Tendinitis
  • When tendons slide back and forth through their sheaths friction is created
  • As with any other moving part, enough friction can cause wear and tear along with inflammation
  • When tendons or sheaths swell, and there is pain and tenderness
wrist tendinitis
Wrist Tendinitis
  • Pain, swelling and inflammation on the thumb side of the wrist
  • Made worse with grasping and twisting activities (polishing and scaling)
  • Occasional “catching” or snapping when moving thumb
carpal tunnel syndrome
Carpal Tunnel Syndrome
  • Compression of the Median Nerve as it passes through the Carpal Tunnel
  • Caused by pinching and gripping activities with the wrist bent
  • Made worse with repetitive flexion and extension activities at the wrists
carpal tunnel syndrome23
Carpal Tunnel Syndrome


  • “Pins and needles” in the hands and fingers
  • Pain in the thumb, index and middle finger
  • Limited range of motion at the wrist
  • Pain radiating up the arm
  • Decreased grip strength
  • More pain at night
trigger finger tenosynovitis
Trigger Finger (Tenosynovitis)
  • Sustained forceful grips and repetitive motion irritates the tendon and tendon sheath (tenosynovium)
  • Nodules form in tendon causing warmth, swelling, tenderness of the tendon
  • Pain occurs during movement that place tendons in tension
  • Fingers lock in “Trigger Position”
cubital tunnel syndrome
Cubital Tunnel Syndrome
  • Prolonged use of the elbow while flexed or trauma from overuse can compress the Ulnar Nerve
  • Pain, numbness, tingling and impaired sensation in the little and ring fingers, side and back of hand
  • Loss of fine control
  • Reduced grip strength

Guyon’s Syndrome

  • Compression of ulnar nerve in Guyon’s canal at the base of the palm
  • Caused by repetitive wrist flexing or excessive pressure on palm/base of hand
  • Pain, weakness, numbness, tingling, burning in the little finger and part of the ring finger
  • Symptoms may worsen at night or early morning
upper crossed syndrome
Upper Crossed Syndrome
  • TightLevator Scapulae Upper Trapezius Scalenes Pectorals
  • WeakMiddle/Lower Traps Rhomboids Serratus Anterior Deep Neck Flexors
  • Elevated shoulders
  • Forward head postures
  • Jutting shoulder blades
  • Neck Pain and Upper Back Pain
low back pain
Low Back Pain
  • Low Back Pain is the leading cause of occupational disability in the dental healthcare profession
  • Studies show that low back pain is clearly related to seated postures and sitting duration
low back pain the problem with sitting
Low Back Pain: The Problem with Sitting
  • With seated postures, pressure in the lumbar disks increases by 50% from standing
  • Unsupported sitting causes 2x more axial loading in the spine than standing
  • During forward flexion and rotation (a position often assumed by dental hygienists) the pressure increases by 200%
low back pain disc degeneration bulge and herniation
Low Back Pain:Disc Degeneration, Bulge and Herniation
  • Spinal discs provide for flexibility shock absorption
  • Discs are composed of tough outer layer (annulus fibrosis) and gel-like center (nucleus pulposis)
  • When weight is applied to the disc, the nucleus expands outward and puts pressure on the annulus fibrosis
low back pain disc degeneration and herniation
Low Back PainDisc Degeneration and Herniation
  • Sitting while flexing forward compresses the discs in the front
  • Uneven pressure on the disc leads to disc bulging and herniation
  • When the disc bulges or herniates backwards the nerves can become pinched
low back pain sciatica
Low Back Pain: Sciatica
  • Pain from lower back or hip radiating to the buttocks and legs
  • Leg weakness, numbness, or tingling
  • Commonly caused by prolapsed intervertebral disc pressuring the sciatic nerve
  • Worsened with prolonged sitting or excessive bending and lifting
low back pain a vicious cycle
Low Back Pain:A Vicious Cycle
  • People with back problems seem to be faced with this vicious cycle
  • There is considerable evidence that bed rest and passive treatments have limited value
  • We now know that activity and the right kind of exercise are critical to treating back pain
lower crossed syndrome
Lower Crossed Syndrome
  • TightHip Flexors Lower Back Muscles
  • WeakAbdominal MusclesGluteus Maximus
  • Swayback - excessive curve of the lower back
  • Anterior Pelvic Tilt - hips tilted forward
  • Lower Back Pain
preventing ergonomic injuries
Preventing Ergonomic Injuries
  • Move
  • Change Position
  • There is no one “correct” posture best for an entire working day
  • The Human Body Needs Change and Mobility
preventing ergonomic injuries stretching guidelines
Preventing Ergonomic InjuriesStretching Guidelines
  • Never stretch to the point of pain or discomfort
  • Do not bounce or use quick, jerky movements
  • Stretch should be performed every half hour
suboccipital muscles
Suboccipital Muscles
  • Deep muscles at the base of the skull responsible for protraction, rotation, and tilting of the head
  • Suboccipitals become shortened with forward head postures
  • Common cause for headaches
levator scapulae
Levator Scapulae
  • Primary function is to elevate the scapula
  • Also bends the neck to the side
  • Tightens up when carrying a bag with a strap or talking on the phone
  • Functions to stabilize the neck during lateral movements
  • Aids in inspiration
  • Becomes tight with awkward leaning positions while seated
  • Upperelevates the shoulders
  • Middleretracts the shoulder blades
  • Lowerrotates the shoulder blade downwards
  • Becomes tight with elevated arm postures
pectoralis minor
Pectoralis Minor
  • Functions to draw the shoulder blade forward and downward
  • Tight in people with a rounded shoulder posture
  • Shortened pec minor is a possible cause for Thoracic Outlet Syndrome
wrist flexors extensors
Wrist Flexors/Extensors
  • Prime function is to flex and extend the wrist
  • “Tennis Elbow” is pain on the lateral side of elbow
  • “Golfer’s Elbow” is pain on the medial side of the elbow
  • Main function is to bend the knee
  • Secondary role in extending the hip
  • Weak low back and glute muscles increases tightness in the hamstrings
  • Prolonged seated postures also causes tight hamstrings
  • Primary function is to flex the hip (bring thigh up towards the abdomen)
  • People with chronic lower back pain often have very tight hip flexors
  • Commonly shortened with prolonged seated postures
  • Main function is to externally rotate the hip/thigh
  • Shortened in people who sit for long periods of time
  • “Piriformis Syndrome” causes compression of the Sciatica nerve